Case Studies: Stahl's Essential Psychopharmacology: Contents
Case 1 |
Case 21  |
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The Case: The man whose antidepressants stopped working The Question: Do depressive episodes become more difficult to treat and more recurrent over time? The Dilemma: When can you stop antidepressant treatment and what do you do if medications that worked in the past no longer work? |
The Case: The woman who has always been out of control The Question: How do you treat chaos? The Dilemma: What can you expect from an antipsychotic in a woman with many problems and diagnoses? |
Case 2 |
Case 22 |
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The Case: The son who would not take a shower The Question: Will a 32-year-old man with an 18-year history of psychotic disorder ever be able to live on his own? The Dilemma: How can aging parents no longer with the health or the means to support an adult patient with a serious mental illness move their son towards independence without decompensating his psychotic illness or making him homeless? |
The Case: The young man with alcohol abuse and depression like father, like son; like
grandfather, like father; like great grandfather, like grandfather The Question: How can you help a young man who denies his alcoholism and depression? The Dilemma: Why do so few psychopharmacologists treat addictive disorders with approved medications? |
Case 3 |
Case 23 |
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The Case: The man who kept hitting his wife over the head with a frying pan The Question: How do you treat aggressive behavior in a patient with early Alzheimer’s Disease? The Dilemma: Can Alzheimer patients ever be treated with black box antipsychotics? |
The Case: The woman with psychotic depression responsive to her own TMS machine The Question: What do you do for TMS responders who need longterm maintenance? The Dilemma: Finding simultaneous medication treatments to supplement TMS for her psychosis, confusion and mood disorder when ECT and clozapine have failed |
Case 4 |
Case 24 |
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The Case: The son who would not go to bed The Question: What do you do when SSRIs and behavioral therapy fail to reverse disability in OCD for more than 19 years? The Dilemma: How to improve quality of life for a patient with treatment resistant OCD still living at home? |
The Case: The boy getting kicked out of his classroom The Question: What is pediatric mania? The Dilemma: What do you do for a little boy with a family history of mania and who is irritable, inattentive, defiant and aggressive? |
Case 5 |
Case 25 |
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The Case: The sleepy woman with anxiety The Question: How can you be anxious and narcoleptic at the same time? The Dilemma: Finding an effective regimen for recurrent, treatment resistant anxious depression while juggling complex treatments for sleep disorder. |
The Case: The young man whose dyskinesia was prompt and not tardive The Question: What is the cause of a profound and early onset movement disorder in a young man who just started a second generation atypical antipsychotic? The Dilemma: How do you treat the psychotic illness without making the movement disorder worse? |
Case 6 |
Case 26 |
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The Case: The woman who felt numb The Question: Are the complaints of a 63-year-old woman with a complex set of psychiatric conditions due to incomplete recovery, or to SSRI induced apathy? The Dilemma: How to have your cake and eat it, too: namely, remission from psychiatric disorders yet no drug-induced cognitive side effects |
The Case: The patient whose daughter wouldn’t give up The Question: Is medication treatment of recurrent depression in an elderly woman worth the risks? The Dilemma: Should remission still be the goal of antidepressant treatment if it means high doses and combinations of antidepressants in a frail patient with two forms of cancer and two hip replacements? |
Case 7 |
Case 27 |
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The Case: The case of physician do not heal thyself The Question: Does the patient have a complex mood disorder, a personality disorder or both? The Dilemma: How do you treat a complex and long-term unstable disorder of mood in a difficult patient? |
The Case: The psychotic arsonist who burned his house and tried to burn himself The Question: How to keep an uncooperative yearold psychotic man with menacing behavior under behavioral control The Dilemma: What can you do after you think you have blocked every dopamine receptor and cannot give clozapine? |
Case 8 |
Case 28 |
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The Case: The son whose parents were desperate to have him avoid Kraepelin The Question: Can you forecast whether an adolescent will become bipolar, schizophrenic or recover? The Dilemma: Should you treat symptoms empirically when the diagnosis changes every time the patient come for a visit? |
The Case: The woman with depression whose Parkinson’s disease vanished The Question: Can state dependent parkinsonism be part of major depressive disorder? The Dilemma: How to diagnose and treat with simultaneous antidepressants and antiparkinsonian drugs? |
Case 9 |
Case 29 |
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The Case: The soldier who thinks he is a “slacker” broken beyond all repair after
3 deployments to Iraq The Question: Are his back injury and PTSD going to end his military career? The Dilemma: Is polypharmacy with 14 medications including multiple opiates, tranquilizers and psychotropics the right way to head him towards symptomatic remission? |
The Case: The depressed man who thought he was out of options The Question: Are some episodes of depression untreatable? The Dilemma: What do you do when even ECT and MAOIs do not work? |
Case 10 |
Case 30 |
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The Case: The young man everybody was afraid to treat The Question: How can you be confident about the safety of combining antihypertensive medications for serious hypertension with psychotropic drugs for serious depression in a patient with a positive urine screen for amphetamine? The Dilemma: Which antidepressants can you use? |
The Case: The woman who was either manic or fat The Question: Will patients be compliant with effective mood stabilizers that cause major weight gain? The Dilemma: Can you find a mood stabilizer that does not cause weight gain or a medication that blocks the weight gain of the mood stabilizer? |
Case 11 |
Case 31 |
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The Case:The young woman whose doctors could not decide whether she has schizophrenia,
bipolar disorder or both The Question: Is there a such thing as schizoaffective disorder? The Dilemma: Does treatment depend upon whether the diagnosis is schizophrenia, bipolar disorder or schizoaffective disorder? |
The Case: The girl who couldn’t find a doctor The Question: How aggressive should medication treatment be in a child with an anxiety disorder? The Dilemma: Can you justify giving high dose benzodiazepines plus SSRIs to a yearold? |
Case 12 |
Case 32 |
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The Case: The scary man with only partial symptom control on clozapine The Question: How to manage breakthrough positive symptoms as well as chronic negative symptoms in a 48-year-old psychotic patient with a history of homicide and suicide attempts? The Dilemma: What do you do when even clozapine does not work adequately? |
The Case: The man who wondered if once a bipolar always a bipolar? The Question:Is antidepressant induced mania real bipolar disorder? The Dilemma: Can you stop mood stabilizers after years of stability following one episode of antidepressant induced mania without boarding a year roller coaster of mood instability? |
Case 13 |
Case 33 |
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The Case: The 8-year-old girl who was naughty The Question: Do girls get ADHD? The Dilemma: How do you treat ADHD with oppositional symptoms? |
The Case: Suck it up, soldier, and quit whining The Question: What is wrong with a soldier returning from his deployment in Afghanistan? The Dilemma: Is it traumatic brain injury, PTSD or postconcussive syndrome, and how do you treat him? |
Case 14 |
Case 34 |
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The Case: The scatter-brained mother whose daughter has ADHD, like mother, like daughter The Question: How often does ADHD run in families? The Dilemma: When you see a child with ADHD, should you also evaluate the parents and siblings? |
The Case: The young man who is failing to launch The Question:What is the underlying illness and when can you make a long term diagnosis? The Dilemma: What can you do for a young adult on a tragic downhill course of social and cognitive decline? |
Case 15 |
Case 35 |
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The Case: The doctor who couldn’t keep up with his patients The Question:Is cognitive dysfunction following a head injury due to tramatic brain injury or to depression? The Dilemma: How can treatment improve his functioning at work? |
The Case: The young cancer survivor with panic The Question:Why is this patient resistant to medication treatments? The Dilemma: How aggressive should psychopharmacological treatment be in terms of dosing and duration of drug treatment for panic? |
Case 16 |
Case 36 |
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The Case: The computer analyst who thought the government would choke him to death The Question: Can you tell the difference between schizophrenia, delusional disorder and obsessive compulsive disorder? The Dilemma: What do you do when antipsychotics do not help delusions? |
The Case: The man whose antipsychotic almost killed him The Question: How closely should you monitor atypical antipsychotic augmentation in a type diabetic with treatment resistant depression? The Dilemma: Can you rechallenge a patient with an atypical antipsychotic for his highly resistant depression when he developed hyperglycemic hyperosmotic syndrome on the medication the last time he took it? |
Case 17 |
Case 37 |
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The Case: The severely depressed man with a life insurance policy soon to lose its
suicide exemption The Question: Is unstable depression without mania or hypomania a form of unipolar depression or bipolar depression? The Dilemma: Do mood stabilizers work for patients with very unstable mood even if the patient has no history of mania or hypomania? |
The Case: The painful man who soaked up his opiates like a sponge The Question: What do you do for a complex chronic pain patient whose symptoms progress despite treatment? The Dilemma: How far can medications go to treat chronic pain? |
Case 18 |
Case 38 |
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The Case: The anxious woman who was more afraid of her anxiety medications than of
anything else The Question: Is medication phobia part of this patient’s anxiety disorder? The Dilemma: How do you treat a patient who has intolerable side effects with every medication? |
The Case: The woman with an ever fluctuating mood The Question: Where does her personality disorder end and where does her mood disorder begin? The Dilemma: Can medication work for mood instability of a personality disorder? |
Case 19 |
Case 39 |
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The Case: The psychotic woman with delusions that no medication could fix The Question: How can you weigh severe side effects with therapeutic benefits of clozapine plus augmentation in a severely ill patient? The Dilemma: Is it possible for a patient to have better functioning even though treatment does not help her delusions? |
The Case: The psychotic sex offender with grandiosity and mania The Question: How to stabilize an assaultive patient with deviant sexual fantasies not responsive to standard doses of antipsychotics and mood stabilizers? The Dilemma: Should heroic doses of quetiapine be tried when standard doses give only a partial response? |
Case 20 |
Case 40 |
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The Case: The breast cancer survivor who couldn’t remember how to cook The Question: What is chemobrain? The Dilemma: Can you treat cognitive dysfunction following chemotherapy for breast cancer? |
The Case: The elderly man with schizophrenia and Alzheimer’s disease The Question: How do you treat a patient with schizophrenia who is poorly responsive to antipsychotics and then develops Alzheimer’s dementia? The Dilemma: Can you give an antipsychotic for one disorder when this is relatively contraindicated for another disorder in the same patient at the same time? |
= designates a "Lightning Round," a short case without a tutorial